Instrument for heart surgery



Oct. 12, 1954 F. J. WALLACE INSTRUMENT FOR HEART SURGERY 2 Shee ts-Sheetl Filud March 27, 1952 INVENTOR.

ATTORNEY Oct. 12, 1954 F. J. WALLACE INSTRUMENT FOR HEART SURGERY 2Sheets-$heet 2 Filed March 27, 1952 IN V EN TOR. FREDERICK J. WALLACEATTORNEY Patented Oct. 12, 1954 metric INSTRUMENT FOR HEART SURGERYFrederick Joseph Wallace, New York, N. Y., as-

Cystoscope Makers, Inc.,

signor to American New York, N. Y.., a c

orporation of New York Application March 27, 1952, Serial No. 278,834

This invention relates to a surgical instrument and, more particularly,to such an instrument that is adapted to be employed advantageously inoperating on the living human heart under conditions of illuminatedvision.

Statistics indicate that heart failure is the leading present-day causeof death in this country. One Of the principal conditions thatcontributes to heart failure is stenosis of a heart passage in theregion of the mitral, aortic or pulmonary valves. Such stenosis is oftena consequence of the thickening of one or another of these valves due torheumatic fever or other degenerative processes. Heart valves that havethus become thickened, or hardened or calcified for any reason, cease tofunction normally and, as a result, cause changes in the rate of flow ofblood from one chamber of the heart to another with attendant illeffects on the health of an individual.

Several surgical procedures have been attempted with the view ofalleviatin these conditions. These procedures have contemplatedproviding an opening through the wall of the heart, inserting a smallknife through the opening and slitting the valve under considerationwith the aid of the knife. These procedures have been limited in theirapplication and have not proven to be satisfactory for the principalreason that they are necessarily blind procedures, and as a consequencethe operating surgeon is unable to view the heart valve that is beingoperated on and isv unable to observe the actual cutting step of theprocedure.

The surgical instrument of this invention successfully overcomes theobjections experienced in earlier procedures as it permits or thecutting of portions of a heart valve under conditions of illuminated andadequate vision. In this connection, the operating surgeon may, by theuse of my instrument, properly view the section of the heart valve to beoperated on and simultaneously sever a portion of such valve in a manneras to permit normal functioning of the valve after the operation iscompleted.

A preferred and recommended surgical instrument constructed inaccordance with this invention includes a support that carries aplurality of parallel forwardly extending tubes that comprise atelescope-receiving first tube, a rod-receivin second tube, alamp-carrier third tube, and a fluid-transmitting fourth tube. Asurgical telescope is positioned within the first tube and dc: finestherewith an annular space that communicates with a conduit which isalso carried by the 12 Claims. ((11. 128- 6) support. A second conduitcarried by the support communicates with the fourth tube. These conduitsand the corresponding tubes permit the introduction and withdrawal ofsuitable liquids into and from selected regions within the heart. Theinstrument is provided with a scissors type tissuesevering meanscomprising a stationary blade disposed forwardly of and in spacedrelation to the distal end of the first tube and the telescope, and amovable blade pivoted at its opposite ends to the stationary blade andto a rod which is slidable in the second tube. The blades are soarranged as to be viewed through the telescope. The rod is reciprocablethrough the medium of a means that will be described in detail furtheralong herein, whereby to impart corresponding pivotal movement to themovable blade relative to the stationary blade.

The primary object of the invention is to provide a surgical instrumentthat is adapted to be used advantageously in internal surgicalprocedures and especially those concerned with the interior of the humanheart.

Another object of the invention is to provide an improved surgicalinstrument capable of being inserted into a living human heart by way ofa previously formed incision and thereupon operated under conditions ofilluminated vision to sever heart tissue, such as tissue that forms partof the mitral, aortic or pulmonary valves.

A further object of the invention is to provide an instrument of thecharacter indicated that is simple and compact in construction,reasonable in manufacturin and upkeep costs, and capable of performingits intended functions in a satisfactory manner.

The foregoing objects, as well asv additional objects, and theadvantages obtainable by the use of the instrument of this inventionwill be readily apparent to persons skilled in the art upon reference tothe following detailed description taken in conjunction with the annexeddrawings which respectively describe and illustrate a preferredembodiment of the invention.

In the drawings:

, Figure l is a top plan view, partly in longitudinal cross section, ofan instrument constructed in accordance with this invention;

Figure 2' is a side elevational view of the instrument shown in Figure1, partly in longitudinal cross section, certain of the parts beingbroken away for better illustration;

Figure 3 is a fragmentary view taken along line 3-3 of Figure 1;

Figure 4 is a View corresponding to Figure 2, a

number of the parts being omitted, other parts being shown in anotherrelative position, and certain parts being shown in cross section;

Figure 5 is an enlarged, cross-sectional view taken along line 5-5 ofFigure 4;

Figure 6 is a view in enlargement takenalong line 6-6 in Figure 2;

Figure '7 is a view in enlargement taken along line 1-1 of Figure 2;

Figure 8 is a view in enlargement taken along line 8-8 of Figure 2; and

Figure 9 is an enlarged view taken from the left of Figure 2.

Referring now to the drawings wherein like reference numerals denotecorresponding parts throughout the several views, the surgicalinstrument illustrated therein includes a tubular sheath l9 that isslightly flared atits forward end It and that is externally threaded atits rearward end 12 for engagement with corresponding threads in atubular support member 13. Sheath I is provided with a circular flange14 immediately adjacent its threaded end portion 12 for abutting theforward end of support member l3 Secured to and forming a fluid-tightfit with support member 13 is a cluster of parallel forwardly projectingtubes, namely, a combined fluid-transmitting and telescope-receivingtube IS, a light-carrier tube l6 and a fluid-transmitting tube llSupport member l3 carries a first conduit 20 having a petcock 21. Thisconduit is adapted to be connected to a source of fluid supply (notshown) and transmit such fluid into tube is by way of a passage 22 inmember $23 (Figure 6) and an opening 23 in the wall of tube 15. Memher[3 also carries a second conduit 24 having a petcock 25. Conduit 24 isadapted to be connected to a partial vacuum (not shown) for effectingwithdrawal of fluid from tube IT by way of a passage 25 in the tubularmember and an opening 27 in the wall of tube ll.

Tubes I5, l and l! are maintained in the illustrated relative positionwith the aid of holding elements 28 (Figure 8), each of which has a rodpassage 29. These passages 29 are aligned and parallel to the axes oftubes l5, l5 and H. Holders 23 may be considered as tubes definingpassages 29 As shown in Figures '7 and 8, tubes or holders 28 arepositioned below tube I5, while tubes l6 and ii are located to oppositesides of a plane common to the axes of tubes l5 and 28. Further, theaxes of tubes It and I? lie intermediate the axes of tubes t5 and 28.This results in a compact tube assemblage that con tributes materiallyto the utility of the instrument as a whole and to the benefitsobtainable by the use thereof in practice.

An electric contact terminal 3b is adapted to be connected to a suitablesource of electric current supply. An electric conductor, comprising awire 3| imbedded in a suitable insulating sheath 32, is secured at oneend to terminal es, extends through a passage 33 in tubular member i3,and then extends through the interior of light-carrier tube 16. Wire 3!makes electrical contact with a miniature lamp 34 that is carried at theforward end of tube l6 (Figures 3 and 9).

As is best shown in Figures 1, 2 and 9, telescope tube I5 is providedwith a plurality of angularly spaced internal projections or teats 35slightly rearward of its forward end. The stem 35 of a surgicaltelescope 3? is adapted to be inserted in tube l5 by way of a throughpassage in member 13. The telescope stem is supported at its forward endby teats 3E and at its rearward end by member !3 in a manner that itforms in annular space i5 with the interior of tube IS. The telescopehas a suitable lens system. including an objective lens 38 (Figure 9),and an eyepiece 39. The lens system is such as to provide an adequateforward field of vision, the necessary illumination being supplied bylamp 34 when the instrument is in active use.

The instrument is provided with a scissors type tissue-severing meansthat will now be described. In this connection, there is secured to thedistal end of tube iii a member 4i; having a bent forward extension 4!that terminates in a stationary or fixed blade 42. This blade has acutting edge '33 that is inclined in downward and forward direction asbest shown in Figure 4. A movable blade M is pivoted at its upper end tothe stationary blade as indicated. at 35. The movable blade is pivotedat its lower end, as indicated at it. to the forward end of an actuatingrod 4'! that is slidable in passages 22!. Blades 42 and 44 are soconstructed and arranged with respect to other parts to lie in the fieldof vision of telescope 3'5.

The instrument is provided with a forceps type control unit Ell forimparting reciprocation to rod ll and corresponding pivotal movement ofmovable blade id with respect to the stationary blade 42. The controlunit includes a support body 5! having an integral saddle 52. As is bestshown in Figures 2, 4 and 6, member l3 rests on saddle 52 and is securedthereto by a pair of screws 53. Also integral with body 5! is a bandlee4 having a thumb-receiving loop 55. Body 5% is provided with a verticalthrough slot and a horizontal groove 5?, best shown in Figures 4 and 5.A slide block til is connected to the rearward end of rod 4? and has anintegral depending rail 61 that rides in groove The slide block isslotted as indicated at 62.

The control unit also includes a movable handle 63 having afinger-receiving loop E i and an upper extension 65 that registers withslot 56 in support body 5! and projects into slot 62 in slide block (38.Handle 83 is pivotally connected to support body 5! by a pivot screw 66.A pin S'i carried by slide block 6i; extends across slot 62 andregisters with a slot 88 in the upper end portion of extension 85. Itwill be apparent from an examination of Figures 2 and 4 that pivotalmovement of handle 53 in one direction effects corresponding movement ofblock 69 and rod 47 and pivotal movement of movable blade M with respectto stationary blade 52. i

For the purpose of briefly outlining the mode of operation of the abovedescribed embodiment of the invention, it is assumed that the instrumentis to be used to operate on a living human heart for the purpose ofsevering portions of the tissue of the mitral valve. The heart isexposed and a purse string suture is placed in the heart. An incision ismade in the left ventrical and the forward end portion of the instrumentis inserted through the incision. The suture is then drawn around sheathin to minimize loss of blood. The instrument is next advanced in theheart to the mitral valve. The parts of the instrument are.

in the relative position shown in Figure 2 and lamp 34 is energizedduring the time the instrument is inserted through the incision andadvanced into the heart. An isotonic saline solution from a suitablesource and under appropriate pressure is then forced into the heart byway of conduit 20, passage 22, opening 23 and annular space 'l'5'-. Thesolution is thus discharged from the instrument in the region adjacentto objective lens -38 of the telescope and moves the blood in theimmediate vicinity of the objective lens but of the way, therebypermitting clear visualization of the parts of the heart directlyforward of the objective .lens. Simultaneously with the foregoing, avacuum isiapplied to conduit 24. With petcock '25 open, the vacuumwithdraws from the heart, by way of tube 11, opening 21, passage 26 andconduit 2-4, anamount of the solution, or a mixture of the solution andblood, equal to the amount introduced into the heart, whereby tomaintaina proper balance. Selected portions of the mitral valve are thensevered under conditions of illuminated vision by operating handle :63of the control unit and correspondingly actuating movable blade 4-4 withrespect to stationary blade 42-. Upon completion of the tissue-cuttingoperation, the instrument is withdrawn from the heart :and necessarysteps are taken to prevent loss of blood through the previously formedincision.

When the instrument is used to operate on the aortic valve, it (isinserted into the heart by way of the carotid artery and the procedurefollowed is similar to that outlined above with respect to operating onthe mitral valve.

From the foregoing, it is believed that the construction, operation andadvantages of my present invention will be readily comprehended bypersons skilled in the art. It is to be clearly understood, however,that various changes in the apparatus set forth may be made withoutdeparting from the scope of the invention, it being intended that allmatter contained in the description or shown in the drawings shall beinterpreted as illustrative only and not in a limiting sense.

I claim:

1, in a surgical instrument of the character described, a support, atube secured to and extending forwardly of the support, tissue-severingmeans comprising a stationary blade disposed forwardly of and in spacedrelation to the forward end of the tube and a movable blade pivoted atone end to the stationary blade, said blades being adapted to be viewedthrough a telescope upon insertion thereof in the tube, a rod pivotallyconnected at one end to the other end of the movable blade, and meanscarried by the support and connected to the other end of the rod forimparting reciprocation to the rod and corresponding pivotal movement tothe movable blade with respect to the stationary blade.

2. In a surgical instrument of the character described, a support, atube secured to and extending forwardly of the support, a member securedto and projecting beyond the forward end of the tube, tissue-severingmeans comprising a stationary blade afiixed to the member and disposedforwardly of and in spaced relation to the forward end of the tube and amovable blade pivoted at one end to the stationary blade, said bladesbeing adapted to be viewed through a telescope upon insertion thereof inthe tube, a rod reciprocable along a path substantially parallel to theaxis of the tube, said rod being pivotally connected at its forward endto the other end of the movable blade, and means carried by the supportand connected to the rear end of the rod for imparting reciprocation tothe rod and corresponding pivotal movement to the movable blade withrespect to the stationary blade.

3. In a surgical instrument of the character atone end to the stationaryblade, said blades bemg adapted to 'b'e'vi'ewed through a telescope uponinsertion thereof in the tube, a rod reciprocable along a pathsubstantially parallel to the axis of the tube, said rod being pivotallyconnected at its forward end to the other end of the movable blade, andmeans carried by the support and connected to the rear end of the .rodfor imparting reciprocation to the rod and corresponding pivotalmovement to the movable blade with respect to the stationary blade, said.last mentioned means comprising a block mounted on and slidable withrespect to the support, a .handle pivotally connected to the support,and means for translating pivotal movement of the handle into slidingmovement of the block.

4. A surgical instrument in accordance with claim 3, wherein the lastmentioned means comprises a pin carried by the block and registeringwith a slot in the handle.

5. In a surgical instrument of the character described, a support, aplurality of parallel tubes secured to and extending forwardly of thesupport and comprising a first tube for receiving a telescope, a secondtube for carrying a lamp, and a third tube for transmitting a fluid,tissuesevering means comprising a stationary blade 'disposed forwardlyof and in spaced relation to the forward end 'of the first tube and amovable blade pivoted at one end of the stationary blade, said bladesbeing adapted to be viewed through a telescope upon insertion thereof inthe first tube, a rod reciprocable along a path parallel to the axes :ofsaid tubes, said rod being pivotally connected at its forward end to theother end of the movable blade, and means carried by the support andconnected to the other end of the rod for imparting reciprocation to therod and corresponding pivotal movement to the movable blade withrespec-tto the stationary blade.

6. In a surgical instrument of the character described, a support, aplurality of parallel tubes secured to and extending forwardly of thesupport and comprising a first tube for receiving a telescope, a secondtube for carrying a lamp, and a third tube for transmitting a fluid, aconduit carried by the support and communicating with the first tube, aconduit carried by the support and communicating with the third tube,tissue-severing means comprising a stationary blade disposed forwardlyof and in spaced rela tion to the forward end of the first tube and amovable blade pivoted at one end to the stationary blade, said bladesbeing adapted to be viewed through a telescope upon insertion thereof inthe first tube, a rod reciprocable along a path parallel to the axes ofsaid tubes, said rod being pivotally connected at its forward end to theother end of the movable blade, and means carried by the support andconnected to the other end of the rod for imparting reciprocation to therod and corresponding pivotal movement to the movable blade with respectto the stationary blade.

7. In a surgical instrument of the character described, a support, aplurality of parallel tubes secured to and extending forwardly of thesupport and comprising a first tube for receiving a telescope, a secondtube for receiving a rod, a third tube for carrying a lamp, and a fourthtube for transmitting a fluid, the axes of the third and fourth tubesbeing disposed to oppositesides of a plane common to the axes of thefirst and second tubes and intermediate the axes of the first and secondtubes, tissue-severing means comprising a stationary blade disposedforwardly of and in spaced relation to the forward end of the first tubeand a movable blade pivoted at one end of the stationary blade, saidblades being adapted to be viewed through a telescope upon insertionthereof in the first tube, a rod reciprocable in the second tube andpivotally connected at its forward end to the other end of the movableblade, and means carried by the support and connected to the other endof the rod for imparting reciprocation to the rod and correspondingpivotal movement to the movable blade with respect to the stationaryblade.

8. In a surgical instrument of the character described, a support, aplurality of parallel tubes secured to and extending forwardly of thesupport and comprising a first tube for receiving a telescope, a secondtube for receiving a rod, a third tube for carrying a lamp, and a fourthtube for transmitting a fluid, the axes of the third and fourth tubesbeing disposed to opposite sides of a plane common to the axes of thefirst and second tubes and intermediate the axes of the first and secondtubes, a conduit carried by the support and communicating with the firsttube, a conduit carried by the support and communicating with the fourthtube, tissue-severing means comprising a stationary blade disposedforwardly of and in spaced relation to the forward end of the first tubeand a movable blade pivoted at one end of the stationary blade, saidblades being adapted to be Viewed through a tele scope upon insertionthereof in the first tube, a rod reciprocable in the second tube andpivotally connected at its forward end to the other end of the movableblade, and means carried by the support and connected to the other endof the rod for imparting reciprocation to the rod and correspondingpivotal movement to the movable blade with respect to the stationaryblade.

9. In a surgical instrument of the character described, a support, aplurality of parallel tubes secured to and extending forwardly of thesupport and comprising a first tube for receiving a telescope, a secondtube for receiving a rod, a third tube for carrying a lamp, and a fourthtube for transmitting a fluid, a telescope in the first tube anddefining an annular space with the interior thereof, a conduit carriedby the support and communicating with said annular space, a rodreciprooable in the second tube, a lamp secured to the forward end ofthe third tube, a conduit carried by the support and communicating withthe fourth tube, tissue-severing means comprising a stationary bladedisposed forwardly of and in spaced relation to the forward end of thefirst tube and a movable blade pivoted at its opposite ends to thestationary blade and the rod, said blades being adapted to be viewedthrough the telescope, and means carried by the support and connected tothe other end of the rod for imparting reciprocation to the rod andcorresponding pivotal movement to the movable blade with respect to thestationary blade.

10. A surgical instrument in accordance with claim 9, wherein the axesof the third and fourth tubes are disposed to opposite sides of a planecommon to the axes of the first and second tubes and lie intermediatethe axes of the first and second tubes.

11. A surgical instrument in accordance with claim 9, wherein said lastmentioned means comprises a block mounted on and slidable with respectto the support, a handle pivotally connected to the support, and meansfor translating pivotal movement of the handle into sliding movement ofthe block.

12. A surgical instrument in accordance with claim 11, wherein the lastmentioned means comprises a pin carried by the block and registeringwith a slot in the handle.

References Cited in the file of this patent UNITED STATES PATENTS NumberName Date 1,127,948 Wappler Feb. 9, 1915 1,627,941 Wappler May 10, 19272.011.,169 Wappler Aug. 13, 1935

